Supporting Life Flashcards
(172 cards)
1
Q
What is pleuritic chest pain?
A
Sudden sharp chest pain when inhaling or exhaling
2
Q
What is normal JVP?
A
3cm vertical height above the sternal angle
3
Q
Give 3 symptoms of aortic stenosis
A
Dyspnoea
Chest pain (angina)
Syncope
4
Q
Give three features of the murmur in aortic stenosis
A
Ejection/midsystolic
Radiates to neck
Located over aortic listening point
5
Q
What ECG features are characteristic of type 2 heart block, Mobitz 1?
A
Progressively elongating PR interval until one P wave fails to conduct and then it resets
6
Q
What ECG features are characteritic of Mobitz 2 heart block
A
Randomly skipped QRSs without being preceeded by progressive PR elongation
7
Q
What is first degree heart block?
A
Elongation of PR interval to greater than 0.22 seconds
8
Q
Give two products of GTN metabolism and their functions
A
NO - vasodilator
Superoxide (O free radical) - inhibits guanylate cyclase, inhibiting vasodilation - affects arteries more than veins - contributes to tolerance
9
Q
What common angina drug is contraindicated in vasospastic angina?
A
Beta blockers (sympathetic stimulation helps dilate coronaries)
10
Q
Give two calcium channel blockers
A
Verapamil
Amlodipine
11
Q
What is Nicorandil and what does it do? (Mechanism of action)
A
Katp channel activator. Stimulates K efflux hyperpolarising smooth muscle.
Also stimulates guanylate cyclase
Vasodilator to lower TPR in angina
12
Q
What does ranolazine do?
A
Reduces cardiac stiffness in angina
13
Q
What does ivabradine do and what is it’s mechanism of action?
A
Reduces HR
Inhibits funny current
14
Q
What is the main 2 ECG finding in ventricular tachycardia?
A
Broad QRS (>0.14) P wave dissociation (tachycardia though, unlike third degree block)
15
Q
What three drugs classes do you use to treat ventricular tachycardia?
A
Classes 1,2,3 - Na blockers - beta blockers - K blockers (Respectively)
16
Q
Give 3 spirometery findings of restrictive lung disease
A
Reduces lung volume (forced vital capacity)
FEV1 not reduced
FEV1/FVC normal or increased
17
Q
Give two causes of diffuse pleural thickening
A
TB
Asbestos
18
Q
What two antifibrotics are used to manage Ideopathic Pulmonary Fibrosis?
A
Pirfenidone
Nintedanib
19
Q
What is ketamines mechanism of action?
A
NMDA antagonist
20
Q
What is benzodiazepines mechanism of action?
A
GABA agonist
21
Q
Give 6 prerenal causes of AKI
A
Hypotension Sepsis Hepatorenal syndrome Heart failure Renal artery occlusion Vasculitis
22
Q
Give three common intrinsic causes of AKI (and their causes)
A
Acute tubular necrosis (hypovoleamia or drugs) Rapidly progressing glomerulonephritis (autoimmune eg lupus) Interstitial nephritis (infection or drugs eg penicillin)
23
Q
Give three post renal causes of AKI
A
Kidney stone
Tumor
Reteriperitoneal fibrosis
24
Q
What ECG shape is found in v high hyperkalaemia (>8.0mmol/l)
A
Sine wave
25
What acid base imbalance does AKI cause?
Metabolic acidosis
26
What are daily maintainence requirements of fluid, sodium, potassium and chloride?
Fluid 25-30ml/kg/day
| Salts 1mmol/kg/day each
27
Give 6 signs of hypovoleamia
```
Fast weak pulse
Postural drop of >20mmhg
Low BP
Loss of skin turgor
Sunken eyes
Dry mucus membranes
```
28
Give 5 signs of hypervolemia
```
Fast, bounding pulse
High BP (but may be low!)
Periferal odema
High JVP
Ascites
```
29
Give three fluids used for resusitiation
Balanced crystalloids (Hartmann)
NaCl (Saline)
Colloids
30
Give two fluids used for maintainence
5% glucose
| 5% glucose w saline
31
Give three symptoms of moderate hyponatreamia (121-129)
Cramps
Weakness
Nausea
32
Give 3 symptoms of severe hyponatreamia (<120)
Lethargy
Headaches
Confusion
33
Give three symptoms of severe and rapidly evolving hyponatreamia <120
Seizures
Coma
resp arrest
34
Give 4 causes of euvoleamic hyponatreamia
Water intoxication
Hypothyroid
Hypopituatary
SIADH (eg from small cell lung cancer)
35
What are daily maintainence requirements of fluid, sodium, potassium and chloride?
Fluid 25-30ml/kg/day
| Salts 1mmol/kg/day each
36
Give 6 signs of hypovoleamia
```
Fast weak pulse
Postural drop of >20mmhg
Low BP
Loss of skin turgor
Sunken eyes
Dry mucus membranes
```
37
Give 5 signs of hypervolemia
```
Fast, bounding pulse
High BP (but may be low!)
Periferal odema
High JVP
Ascites
```
38
Give three fluids used for resusitiation
Balanced crystalloids (Hartmann)
NaCl (Saline)
Colloids
39
Give two fluids used for maintainence
5% glucose
| 5% glucose w saline
40
Give three symptoms of moderate hyponatreamia (121-129)
Cramps
Weakness
Nausea
41
Give 3 symptoms of severe hyponatreamia (<120)
Lethargy
Headaches
Confusion
42
Give three symptoms of severe and rapidly evolving hyponatreamia <120
Seizures
Coma
resp arrest
43
Give 4 causes of euvoleamic hyponatreamia
Water intoxication
Hypothyroid
Hypopituatary
SIADH (eg from small cell lung cancer)
44
Give three non renal (urine na <25mmol/l) hyponatreamia
| Hypervolemic
Congestive heart failiure
Cirrhosis
Nephrotic syndrome
45
Give a renal (urine na >30 mmol/l) cause of hyponatreamia
| Hypervoleamic
CKD (kidneys fail to excrete water but not na)
46
Give three non renal (urine na<25) of hyponatreamia
| Hypovoleamic
GI loss
Dermal loss (sweat)
3rd spacing of fluids
47
What is the management for hypovoleamic hyponatreamia?
0.9% IV saline
48
What is management for euvoleamic or hypervoleamic hyponatreamia?
Treat underlying cause
| Fluid restriction
49
Give two causes of hypernatreamua due to sodium overload
Administration of high salt load by IV fluids
| Hyperaldosteronism (conns disease = primary hyperaldosteroneism)
50
What’s the management for hypernatreamia?
Give hypotonic fluid eg 5% dextrose slowly to dilute it
51
Give 3 symptoms of hyperkaleamia
Muscle weakness/paralysis
paraestheasia
Arrhythmia
52
Give 3 treatments for hyperkaleamia
```
Insulin + glc (insulin drives potassium into cells)
IV calcium (antagonises K effect of cardiac membranes)
Remove K+ via loop diuretics or heamodyalysis
```
53
give 4 causes of hypokaleamia
reduced intake
Entry into cells due to alkalosis
GI/urine/sweat loss
Hyperaldosteronism
54
give 4 clincal manifestations of hypokaleamia
Muscle weakness
ECG changes
Renal abnormalities
rhabdomyelisis
55
Give 3 ECG features typical of hypokaleamia
U wave
ST depression
flat T wave
long QT
PR elongation
(U DEPRESSED Fam)
56
give 4 causes of high anion gap metabolic acidosis
ketoacidosis
lactate acidosis
renal failiure!! (eg. in AKI)
Toxins eg. asprin
57
Give 3 causes of normal anion gap metabolic acidosis
Diahorrea
Surgical drains
Renal tubular acidosis
All due to loss of Hco3 without gain of other unmeasureable anions
58
Is COPD eaosinophilic or non?
non eosinophilic
59
Give 3 main symptoms of COPD
Sputum
Wheeze
Dyspnea
60
What is Cor pulmonal?
Enlargement of R heart due to lung disease (occurs in COPD)
| Due to reflexive vasoconstriction due to low pO2 in lungs
61
Give 5 lung number changes in COPD
```
inc resp rate
inc FRC
inc residual volume
dec inspiratory capacity
dec inspiratory reserve volume
```
62
Give 5 airway changes in COPD
```
Chronic Bronchitis
Emphysema
Cillia destuction
increased goblet cells
Bronchial submucosal gland hyperplasia/dysplasia
```
63
Give 3 inflammatory cells in COPD
Neutrophil
CD8
fibroblast
(Not Eosinophil!)
64
what is the most common microorganism causing pneumonia?
Strep. Pneumoniea
65
give 5 factors that score a point in the CURB65 scoreing system for pneumonia?
```
confusion
serum urea >7mmol
Resp rate >30
BP below 90 systolic or 60 diastolic
aged 65 or older
```
66
Give 4 common causes of community aquired pneumonia
strep pneumonia
Viral (influenza a/b)
Staph Aureus
Heamophilus influenzae
67
What Abx should be added if a pateint for pneumonia has risk factors for MRSA
Vancomycin
68
What pathogen causes legionaires disease?
Legionella pneumophillia
69
What is non pneumonia legionella infection called?
Pontiac fever
70
What is typical history exposure suggesting legionaires?
Water exposure
71
in addition to pneumonia symptoms, what are the 2 classic signs of legionaires?
prominent headache
| fever w/o tachycardia
72
What Abx class should you use for legionaires disease? 2 available
fluroquinolone (eg. levofloxacin)
| Macrolide (eg. axithromycin)
73
give 2 common organisms causing atypical pneumonia
Mycoplasma pneumoniae
| Chlamydophila pneumoniae
74
give a typical symptom of atypical pneumonia
hoarseness
75
What demographic does atypical pneumonia typically affect?
young adults living in close proximity
76
What antibiotic should be used for athypical pnemonia?
Macrolides (eg. azithromycin)
| - standard pneumonia treatment includes this for coverage as penicillin wont work on these
77
Give two common organisms causes hospital aquired pneumonia
Psudomonus Aeruginosa
| E. Coli
78
Give 4 causes of immunocompromise causing increased pneumonia susectibility
```
neutrophil defect (chemo therapy)
Abx defect (primary immune deficiency)
T cell defect (HIV)
High does steroid (eg for rheumatoid artheritits)
```
79
What is the antifungal of choice for aspergillus infection of lungs?
Voriconazole
80
Give three causes of pneumonia specific to immunocompromised patients
Aspergillus
Nocardia
Pneumocystis jiroveci
81
What is the CT finding in Aspergilllus infection
'halo sign' - circle like structures in lungs
82
What type of immunocompromise is typically seen in patients with nocardia
T cell eg. HIV, high dose steroids, post transplant
83
what abx do you use to treat nocardiosis and pneumocystis jirovecci?
septrin (a combination)
84
is asthma, what does IL-13 do?
Mucus hypersecreation
85
In asthma, what does IL-5 do?
Attacts and degranulates eosinophils
86
Give four signs of infective endocarditis
Fever
Murmurs
Vegetations on echo (lesions)
Positive blood cultures (commonly staph aureus)
87
What two types of hypersensitivity is asthma?
type 1 and type 4
88
give two actions of histamine released from mast cells in asthma
Vasodilation (causes mucosal odeama)
| Bronchoconstriction
89
Give two actions of tryptase is asthma
remodels tissue
| mucus hypersecreation
90
give two functions of the de novo produced prostaglandin (PGD2) in asthma
vasodilation
| bronchoconstriction
91
Give one function of leukotrienes de novo produced by mast cells in asthma
bronchoconstriction
92
give four outcomes of the tissue remodeling in asthma due to tryptase
epithelial cell damage causing odema
BM thickening
Airway SM thickening
Mucusgland hypertrophy
93
What is the normal function of eaosinophils
killing of extracellular parasites
94
what two classes of bronchodilators are used in asthma
B2 agonists
| anticholinergics/antimuscarinics
95
give three long acting beta 2 agonists used in asthma
vilanterol
salmetorol
formoterol
96
give 2 anticholinergics used in asthma bronchodilation
ipratropium
| tiotropium
97
give one inhaled corticosteroid used in asthma
Fluticasone
98
what class of drugs can be used instead of ICS (inhaled corticosteroids) i asthma for children
Leukotriene Receptor Antagonists (LTRA)
eg. Nedocromil
99
What three types of hepatitis virus are likely to cause chronic infection
B,C,D
100
what type of drug is bendroflumethiazine?
thiazide diuretic
101
Give two potassium sparing diuretics
amiloride
| spirolactone
102
Give 5 drug classes to give in urgent/severe asthma exacerbation
```
SABA
Anticholinergic (ipatropium bromide)
O2
Corticosteroid (Oral or IV) - Prednisolone
IV magnesium
```
103
How long should one canister of inhaled corticosteroid last for a asthma patient?
1 month
104
What organism most likely causes infective endocarditis from dental procedures?
Strep. Viridans
105
What organism is the most common cause of infective endocarditis? Esp in IVDU
Staph aureus
106
Give four drugs/ classes that can causes SIADH
Sulphonylurea
SSRI
Tricyclic antidepressants
Carbamazapine
107
What is the maximum safe rate to raises sodium in hyponatreamia
8mmol/d
108
What does raising serum sodium too quickly put pt at risk of?
Central pontine myelinolysis
109
What is the most common lower resp tract infection in <1 yros and what is the causative organism?
Bronchiolitis
| Resp. syncytial virus
110
Give four pharmocodynamic effects of propofol
Apnoea (30s to 30min)
Decreased CO and TRP (therefore decreaed BP)
decrased ICP (allows for normal CPP with the lower BP)
antiemetic
111
Give three barbiturates
Thiopental
Methoxital
Phenobarbital
112
Give four pharmocodynamic effects of barbiturates
| and what system is it protective of?
Apnoea
Decreased CO (periferal vasodilation and -ve ionotropy)
decreased ICP and cerebral o2 demand
seizure supression
Overll, good neuroprotective eg. good for head trauma
113
give three pharmacodynamic effects of benzodiazepines
| and what system are they protective of?
No apnoea (but decreased upper airway tone)
Only v small BP drop
anticonvulsant
Anxiolysis (reduces anxiety)
V cardioprotective - heamodynamically stable
114
Give a benzodiazepine antagonist
Flumezanil
115
Give three pharmacodynamic effects of ketamine and on what patients is it good to use of?
No apnoea
Increased BP, HR, CO
Increased ICP, cerebral metabolic O2 demand
Good for heamodynamically unstable Pts
116
Give three pharmacodynamic actions of etomidate and for what patients is it good for?
transient hyperventiation followed by apnoea
raised BP
decreased ICP
Good fro heamodymically unstable Pts
117
Give two pharmacodynamic effects of dexmedetomidine and what patients is it good for?
```
No apnoea or resp depression
decreased CO (bradycardia)
```
Good for awake craniotomy
118
Give 6 pharmacodynamic effects of morphine
```
huge resp suppresion
cardio stable
sedation/euphoria
constipation
pruritis
Biliary constriction
```
119
Give the 4 main opioids in order of potency
Fentanyl
Morphine
Codine
Tramadol
120
Which opioid has the shortest action (cotext sensitive half life)
Remifentanyl
121
Which two induction agents raised the CO/BP so are good for heamodynamically unstable Pts?
Ketamine
| Etomidate
122
Which two induction agents casue apnoea, decreased BP and decreased ICP?
Propofol
| Barbiturates
123
Give two cardiac complications of bicuspid aortic valve
Aortic stenosis
| Aortic regurgitation
124
Give two disgnostic findings suggestive of mitral stenosis
(late) Diastolic murmur
| May have irregularly irregular heartbea - like AF
125
Give four cardiovascular complications which may occur in Marfans
Aortic dissection
Aortic Aneurysm
Aortic regurgitation
Mitral Prolapse
126
Apart from height, give two feature of sppearence of Marfans
High Arched Palette
| Scoliosis
127
What arrhythmia is an indication for a permanant pacemaker?
3rd degree heart block
128
Give two ECG findings of NSTEMI
T wave inversion
| ST depression
129
Rheumatic fever is a complication of what infection?
Streptococcal pharyngitis
130
Wha vavular defect is a common complication of rheumatic fever?
Mitral Stenosis
131
Give 2 ECG features of pericarditis
PR depression
| Saddle Shaped ST elevation
132
Give four causes of pericarditis?
Viral infection
Dressler's syndrome - post MI
TB
ureamia
133
Give three signs/symptoms of Pericarditis
Peuritic chest pain (stabbing, worse on inspiration)
Alleviated by sitting forward
Pericardial rub
134
What is S3 heart sound usually a sign of?
systolic heartfailiure but may be normal eg in pregnancy or atheletes (increased complience)
135
What is S4 heart sound usuallya sign of?
Diastolic heart faililure- hypertrophy. Also may be due to active ischeamia (caused by decreased complience)
136
When does a physiological spilt of S2 happen?
Inspiration
137
What does a fixed spil of S2 suggest
Atrial septal defect
138
What does a paradoxical split of S2 suggest?
Aortic stenosis
Left bundle branch block
(any condition resulting in a delay in Aortic closure)
139
What does a widened S2 split suggest?
RBBB
Mitral regurg
(any condition that casues a delay to pulmonary closure or early aortic closure)
140
What does a mid systolic click suggest
Mitral prolapse
141
How do you treat AKI caused by acute interstitial nephritis
steroids
142
Give 2 formulea used to estimate GFR from serum creatinine and which is better?
MDRD (better and more commonly used)
| Cockroft and Gault
143
Why would you give Epo injections in CKD
For renal aneamia (Epo is the activated for of erythropoetin)
144
What is IgA nephropathy and give 4 symptoms of it
```
IgA deposition in kidneys causing glomerularnephritis
Microscopic heamaturia
HTN
Proteinurea
Progressive renal impairment
(Ix with serum IgA)
```
145
What genetic condition causes glomerulonephritis (with universal heamaturia) and hearing loss
Alports disease
146
Give 2 macrolides
Azithomycin
| Erythromycin
147
Give the class of and an example of the Abx used in serious sepsis
Gentamycin
class is aminoglycosides
148
give two glycopeptides and are they better against gram +ve or -ve?
Vancomycin (used against MRSA)
Teicoplanin
only work aginst +ve
149
Give two Quinolones (flouroqinolones) and state is theyre better against gram +ve or -ve
Levoflouracin
Ciproflouracin
Better agianst -ve (used in legionaires)
150
Give 7 signs of tension pneumothorax
```
Resp distress
tachycardia
hypotension
distended neck veins
increased resonance
decreased breath sounds
trachea devated away
```
151
Give two features that may suggest tension over normal pneumothorax
Trachea deviated away
| distended neck veins
152
What is Becks triad for Cardiac tamponarde
Raised JVP
Falling BP
Muffled Heart Sounds
153
what would tousarde de pointsshow on ECG?
Rapid, irregular QRS that twist around the baseline
154
What ECG abnormality is Tousarde de points associated with?
Long QT
155
Give 7 post MI complications
```
VT
Pericarditis
papillary muscle dysfunction
mural thrombosis
ventricular rupture -> tamponarde
ventricular anurysm
dressler syndrome
```
156
What 2 examination findings are typical in restrictive lung disease
Clubbing and crackles
157
How do you differentiate ideopathic pulmonary fibrosis and non-specific interstital pneumonia (3 things)
Non specific interstitial pneumonia is autoimmune associated (eg lupus), has ground glass opacities in CT and has no honeycombing
158
What happens in sarcoidosis
non ceasating granulomatous inflammation affecting the lungs, eyes and skin (may produce a interstitial lung disease)
159
are left sided murmurs louder on inspiration or expiration and vice versa?
Left sided = louder on expiration
| right sided = louder on inspiration
160
Give 2 blood changes that may occur in shock?
increased neutrophils
| decreased coagulation time
161
give the four stages of shock classfication (according to %blood lost)
```
1 = 0 -15%
2 = 15-30%
3 = 30-40%
4 = >40%
```
162
Give three treatments for Delayed sleep phase disorder?
Phototherapy
Low dose melatonin
CBT
163
How is shift work disorder diagnosed?
Insomnia/ excessive daytime sleepiness for over 1 month
| Diagnosis of exclusion
164
During which halves of the night do NREM and REM parasomnias happen (respectively)
```
NREM = 1st half
REM = 2nd half
```
165
What is the overall cause of concentric hypertrophy and give 2 specific causes of this?
Give the basic process of concentric hypertrophy
Pressure overload
HTN, Aortic stenosis
Wall bulks up, radius decreases, whole thing dilates
166
What is the overall cause of dilated cardiomyopathy and give 1 specific causes of this?
Give the basic process of dilated cardiomyopathy
Volume overload
Aortic regurgitation
wall bulks up, radius also increases
167
Give 3 reasons why COPD presents with breathlessness
expiratory flow rate cant increasd much
Needs dynamic hyperinflation to increase expiratory flow which requires lungs to work at level with lower complience
functional diaphragm weakness (as its already flattened)
168
Which is eosinophilic, COPD or asthma?
Asthma
169
give 3 KDIGO definition of AKI
```
raise of serum creatinine of >26.5 (88-150) in 48 hr
OR
1.5x raise in serum creatinine in 7 days
OR
<0.5ml/kg/hr of urine output for 6 hours
```
170
Give 3 consequences of retention of metabolic waste product in AKI?
Encephalitis
Pericarditis (may progress to tamponarde)
pleurisy
171
What is the overall process that causes type 1 resp failiure?
VQ mismatch (eg. pulmonary odema, PE, pneumothorax)
172
What is the overall process that causes type 2 resp failiure?
Disruption of the ventilatory apparatus (eg. stoke, fail segment ect.)
